Objective To observe the efficacy and safety of Roxadustat in the treatment of renal anemia with low erythropoietin (EPO) response in hemodialysis (HD) patients. Methods The HD patients treated with Roxadustat for renal anemia and low EPO response were enrolled in this retrospective and self-controlled study. Baseline was defined as the conditions before switching to Roxadustat treatment. Hemoglobin (Hb), iron metabolism indexes, blood lipids, biochemical indexes, blood pressure and hematological indexes were measured at baseline and observation time points after treatment. Adverse drug reactions during the treatment period were collected. Results Forty-two HD patients were enrolled in this study. Their average age was 49±13 years old, and dialysis age was 36.88±30.44 months. The leading primary diseases were chronic glomerulonephritis (n=22, 52.38%) and diabetic nephropathy (n=10, 23.81%). The baseline Hb was 85.85±11.14 g/L. The average Hb levels at the 2nd, 4th, 8th, 12th, and 24th weeks of the treatment were significantly higher than the baseline Hb level (F=55.590, P<0.001). After 24 weeks of Roxadustat treatment, the compliance rate of Hb was 83.33% (35 cases), and the response rate to Roxadustat was 92.86% (39 cases). After 12~24 weeks of Roxadustat treatment, serum iron (F=6.706, P=0.003), total iron binding capacity (F=32.368, P＜0.001), hematocrit (F=22.513, P＜0.001), red blood account (F =26.738, P＜0.001), mean corpuscular volume (F=3.327, P=0.046), and mean corpuscular hemoglobin (F=4.589, P=0.016) increased, and serum ferritin (F=3.584, P=0.037) and low density lipoprotein (F=8.169, P=0.007) declined. No serious adverse events occurred in these patients. Conclusion Roxadustat can safely and effectively improve iron metabolism, reduce blood lipids, and increase Hb level in HD patients with renal anemia and low EPO response.
GUO Gang-Ling
,
WU Ling-Yu
,
FAN Pei-Qi
,
PAN Zhen-Xin
,
ZHANG Ping
,
LI Jing
,
WANG Li-Hua
. The clinical study of Roxadustat in the treatment of renal anemia with low erythropoietin response in hemodialysis patients[J]. Chinese Journal of Blood Purification, 2022
, 21(12)
: 893
-897
.
DOI: 10.3969/j.issn.1671-4091.2022.12.007
[1] Li, Y. Prevalence, awareness, and treatment of anemia in chinese patients with nondialysis chronic kidney disease: First multicenter, cross-sectional study.[J].Medicine, 2016, 95((24)): e3872- e3872
[2] Hanna, R.Burden of anemia in chronic kidney disease: Beyond erythropoietin.[J].Advances in therapy, 2021, 38((1)):52-75
[3] Luo, J.Spectrum and burden of erythropoiesis-stimulating agent?hyporesponsiveness among contemporary hemodialysis?patients.[J].American journal of kidney diseases : the official journal of the National Kidney Foundation, 2016, 68((5)): 763-771.
[4] Voit, R. Stabilizing hif to ameliorate anemia.[J].Cell, 2020, 180((1)): 6- 6
[5] 中国医师协会肾脏内科医师分会肾性贫血指南工作组.中国肾性贫血诊治临床实践指南。[J].中华医学杂志, 2021, 101((20)):1463-1502
[6] 余学清, .肾性贫血诊断与治疗中国专家共识(2014修订版)。[J].中华肾脏病杂志, 2014, 30((09)):712-716
[7] Weir, M.Managing anemia across the stages of kidney disease in those hyporesponsive to erythropoiesis-stimulating agents.[J]. , [J].American journal of nephrology, 2021, 52((6)):450-466
[8] Akizawa, T.Oral roxadustat three times weekly in esa-na?ve and esa-converted patients with anemia of chronic kidney disease on hemodialysis: Results from two phase 3 studies.[J].Ther Apher Dial, 2020, 24( (6)):628-641
[9] Chen, N.Roxadustat treatment for anemia in patients undergoing long-term dialysis.[J].N Engl J Med, 2019, 381((11)):1011-1022
[10] Chen, N.Phase 2 studies of oral hypoxia-inducible factor prolyl hydroxylase inhibitor fg-4592 for treatment of anemia in china.[J].Nephrol Dial Transplant, 2017, 32( (8)):1373-1386
[11] Mercadal, L.The relation of hepcidin to iron disorders, inflammation and hemoglobin in chronic kidney disease.[J].PLoS One, 2014, 9((6)):e99781-e99781
[12] Lee, S.Serum hepcidin may be a novel uremic toxin, which might be related to erythropoietin resistance.[J].Sci Rep, 2017, 7((1)):4260-4260
[13] de Las Cuevas Allende, R.Anaemia of chronic diseases: Pathophysiology, diagnosis and treatment.[J].Med Clin (Barc), 2021, 156((5)):235-242
[14] Agarwal, A.Iron metabolism and management: Focus on chronic kidney disease.[J].Kidney Int Suppl, 2021, 11((1)):46-58
[15] Wojtaszek, E.Iron and chronic kidney disease: Still a challenge.[J].Front Med (Lausanne), 2020, 7(（）):565135-565135
[16] 许曼曼, 王俊, and 谢俊霞. 低氧诱导因子对铁代谢的调节（英文）[J].生理学报, 2017, 69((05)):598-610
[17] Marsch, E. Deficiency of the oxygen sensor prolyl hydroxylase 1 attenuates hypercholesterolaemia, atherosclerosis, and hyperglycaemia.[J].Eur Heart J, 2016, 37((39)):2993-2997
[18] Hwang, S.Hypoxia-inducible factor 1α activates insulin-induced gene 2 (insig-2) transcription for degradation of 3-hydroxy-3-methylglutaryl (hmg)-coa reductase in the liver.[J].J Biol Chem, 2017, 292((22)):9382-9393
[19] Rahtu-Korpela, L.Hypoxia-inducible factor prolyl 4-hydroxylase-2 inhibition protects against development of atherosclerosis.[J].Arterioscler Thromb Vasc Biol, 2016, 36((4)): 608-617
[20] Provenzano, R.Roxadustat for anemia in patients with end-stage renal disease incident to dialysis.[J].Nephrol Dial Transplant, 2021, 36((9)):1717-1730
